HomeMy WebLinkAbout198337 06/15/2011 CITY OF CARMEL, INDIANA VENDOR: 00350929 Page 1 of 1
O ONE CIVIC SQUARE INDIANA DEPT OF REVENUE CHECK AMOUNT: $109.68
CARMEL, INDIANA 46032 PO BOX 7229
INDIANAPOLIS IN 46207 CHECK NUMBER: 198337
CHECK DATE: 6/15/2011
DEPARTMENT ACCOUNT PO NU MBER INV OICE N UMBER AMOUNT D ESCRIPT ION
101 5023990 1 109.68 F B TAX -5/11
AWhw Signa M FAB -10 3 0 810
X urc
Af 1 1 declare under pen ties orrperjury t at r tr •co cct and complete r
f A Total Sales of Food Beverages (Do Not Include Tax) A. I I V I
Date Phone�� I
Total Exempt Food Beverage Sales B.
BROOKSH IRE GOLF CLUB Net Taxable Sales (Subtract Line B from Line A) C. I U 9(l I
CARMEL UTILITIES I I o 4q
Taxpayer ID Number For Tax Period Tax Due (I% of Line C) D.
0003120155 009 0 MAY 2011
Collection Allowance (.73 %of Line D) a i
Do Not Use this Line ifthe Payment is Late E. O
County /Town Due on or Before Net Tax Due (Subtract Line E from Line D) F.
Penalty is Greater of S5 or 10% of Line F (Plus Interest)'
Hamilton JUN 30 2011 Use this line only ifretum is filed late G.
'The 2011 Annual Interest Rate is 9%
Adjustments (An explanation must be attached) H.
I ttltltl�Ir�ttllltlltt�tlltt�lliiilll Total Amount Due (Total Lines F and G plus or minus H) I.
INDIANA DEPARTMENT OF REVENUE
P-O- BOX 7229
INDIANAPOLIS,IN 46207 -7229
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Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 201 (Rev. 1995)
CITY OF CARMEL
An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by
whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc.
Payee I
J� l��L Purchase Order No.
Terms
Date Due
Invoice Invoice Description Amount
Date Number (or note attached invoice(s) or bills
Total
I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance
with IC 5- 11- 10 -1.6.
20
Clerk- Treasurer
VOUCHER NO. WARRANT NO.
ALLOWED 20
IN SUM OF
7-
ON ACCOUNT OF APPROPRIATION FOR
Board Members
PO# or INVOICE NO. ACCT #/TITLE AMOUNT
DEPT. I hereby certify that the attached invoice(s), or
d� bill(s) is (are) true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
20
Signatur
Title
Cost distribution ledger classification if
claim paid motor vehicle highway fund